MEDICARE: NIKKI CHANTELLE GALLARDO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW.09932589	CO
2	1041C0700X	Clinical Social Worker	LCSW-1887	WY

General Provider Information

NPI Number	:	1366372609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI CHANTELLE GALLARDO LCSW

Provider Business Mailing Address
First Line	:	1950 GET LUCKY TRL
Second Line	:	APT B
City	:	CHEYENNE
State	:	WY
Zip	:	82007
Country	:	US
Telephone Number	:	785-789-2239
Fax Number	:

Provider Business Practice Location Address
First Line	:	2402 PIONEER AVE
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-3021
Country	:	US
Telephone Number	:	307-757-5907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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